让外科医生回顾当前和未来新辅助免疫疗法在局限性结直肠癌患者中的应用。免疫疗法彻底改变了肿瘤学的护理标准，并改善了多种癌症的生存结果。然而，免疫疗法的适用性仍然是一个持续的挑战。一些癌症类型对免疫治疗的反应较差，并且癌症类型内反应的异质性知之甚少。患者的临床特征、与手术相关的免疫治疗时机、免疫反应的多样性、克隆异质性、肿瘤微环境的不同特征以及遗传改变是可能影响免疫治疗疗效的众多因素中的一些因素。回顾中，我们描述了用于治疗局限性结直肠癌的主要免疫疗法类型。此外，我们讨论了与生物标志物和放射学评估相关的免疫治疗反应的预测。最后，我们考虑了临床意义和反应模式的未来前景，以及新辅助免疫治疗在局限性结直肠癌中的潜力和挑战。诊断时确定错配修复状态对于新辅助免疫治疗的潜在应用至关重要，特别是免疫检查点抑制剂，用于局部结直肠癌。迄今为止，疗效主要见于错配修复状态不足和 POLE 突变的患者，尽管一小部分错配修复良好的患者确实有反应。总之，新辅助免疫疗法显示出有希望的完全缓解率，这可能为一组患者开辟一条保留器官的观察等待方法的未来途径。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To give surgeons a review of the current and future use of neoadjuvant immunotherapy in patients with localized colorectal cancer.Immunotherapy has revolutionized the standard of care in oncology and improved survival outcomes in several cancers. However, the applicability of immunotherapy is still an ongoing challenge. Some cancer types are less responsive to immunotherapy, and the heterogeneity in responses within cancer types is poorly understood. Clinical characteristics of the patient, the timing of immunotherapy in relation to surgery, diversities in the immune responses, clonal heterogeneity, different features of the tumor microenvironment, and genetic alterations are some factors among many that may influence the efficacy of immunotherapy.In this narrative review, we describe the major types of immunotherapy used to treat localized colorectal cancer. Furthermore, we discuss the prediction of response to immunotherapy in relation to biomarkers and radiological assessment. Finally, we consider the future perspectives of clinical implications and response patterns, as well as the potential and challenges of neoadjuvant immunotherapy in localized colorectal cancer.Establishing mismatch repair status at the time of diagnosis is central to the potential use of neoadjuvant immunotherapy, in particular immune checkpoint inhibitors, in localized colorectal cancer. To date, efficacy is primarily seen in patients with deficient mismatch repair status and POLE mutations, although a small group of patients with proficient mismatch repair does respond. In conclusion, neoadjuvant immunotherapy shows promising complete response rates, which may open a future avenue of an organ-sparing watch-and-wait approach for a group of patients.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.